When it comes to medical aid in South Africa, one of the most important protections for members is Prescribed Minimum Benefits (PMBs). These are a set of benefits that all medical schemes are legally required to cover, no matter which plan you choose.
What Are PMBs?
PMBs are defined in the Medical Schemes Act (No. 131 of 1998). They ensure that members are guaranteed access to a minimum level of healthcare. In simple terms, it’s a safety net that makes sure your medical scheme can’t deny cover for essential treatment.
PMBs fall into three categories:
- Emergency medical conditions – sudden, unexpected events where delaying care could lead to serious harm or death.
- Chronic conditions – a list of 26 chronic diseases, such as diabetes, asthma, epilepsy, and hypertension.
- Specified conditions – nearly 271 medical conditions (including treatments and diagnostic tests) that schemes must cover.
Why Do PMBs Exist?
Healthcare can be expensive, and without regulation, members could easily be left unprotected against high medical costs. PMBs were designed to:
- Protect members from large, unexpected expenses.
- Make sure everyone has access to basic healthcare.
- Standardise cover so that all medical scheme members receive a fair minimum, no matter the option they are on.
How Must Schemes Cover PMBs?
Medical schemes must cover PMBs in full if you use the scheme’s designated service providers (DSPs). However, if you choose not to use a DSP (unless in an emergency or if the service is not available), you might have to pay part of the bill yourself.
Why Should Members Care?
- Peace of mind: You’re guaranteed cover for certain conditions, regardless of your plan.
- Financial protection: Serious or chronic illnesses won’t wipe out your savings.
- Legal right: If your scheme refuses PMB cover, you can lodge a complaint with the Council for Medical Schemes (CMS).
At SDC Wealth, we simplify the complexities of medical aid. Helping you understand your benefits, know your rights, and choose cover that suits your lifestyle and budget.
Our experienced team ensures that you make informed healthcare decisions, backed by expert advice and personalised service.
SDC Wealth offers customised financial solutions built around your goals and circumstances. Whether for you, your business, or your employees, our advisors provide expert guidance to help you understand and optimise your Wealth Creation and Wealth Protection strategies. SDC Wealth is an authorised financial services provider (FSP49659).
